Individual
NICOLE SISSON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
514 S BROWN ST, SPRINGFIELD, TN 37172-2937
(615) 988-4552
(615) 382-0501
Mailing address
PO BOX 1637, SPRINGFIELD, TN 37172-1637
(615) 988-4552
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
6791
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6791
STATE LICENSE
TN
Enumeration date
02/25/2021
Last updated
02/25/2021
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